Intshayelelo
I-Achalasia ye-cardia (AC) yiIngxaki yokuqala ye-esophageal motility.Ngenxa yokungaphumli kakuhle kwe-esophageal sphincter (LES) kunye nokungabikho kwe-esophageal peristalsis, ukugcinwa kokutya kubangeladysphagia kunye nokusabela. Iimpawu zeklinikhi ezifana nokopha, intlungu yesifuba kunye nokulahlekelwa kwesisindo.Ubuninzi bumalunga ne-32.58/100,000.
Iunyangoye achalasia ikakhulu ibandakanya unyango non-utyando, unyango dilation kunye nonyango lotyando.
01UNyango lwezoNyango
Indlela yonyango yonyango kukunciphisa uxinzelelo lwe-LES kwixesha elifutshane.Akukho bungqina bucacileyo bokuba iziyobisi zinokuqhubeka kwaye ziphucule ngokufanelekileyo iimpawu ze-AC.Okwangoku iziyobisi ezisetyenziswa ngokuqhelekileyo ziquka i-nitrate, i-calcium channel blockers, kunye ne-β-receptor agonists.
(1)IiNitrate, njenge-nitroglycerin, i-amyl nitrate, kunye ne-isosorbide dinitrate
(2)Izithinteli zesitishi seCalcium, njenge-nifedipine, i-verapamil, kunye ne-diltiazem
(3)I-β-receptor agonists, njenge-cabuterol
02 Isitofu seToxin ye-Endoscopic yeBotulinum (BTI)
Inaliti ye-endoscopic ye-botulinum (BTl) ingasetyenziselwa ukunyanga i-AC,kodwa inokubonelela ngemiphumo yexesha elifutshane kwaye ingasetyenziselwa izigulane ezisebekhulile ezinobungozi obukhulu bokuhlinzwa kunye ne-anesthesia.
1) Iimpawu:izigulane ezineminyaka ephakathi kunye nabantu abadala (> iminyaka engama-40 ubudala); abo bangakwaziyo ukunyamezela ibhaluni ye-endoscopic dilation (PD) okanye unyango lotyando; abo banonyango oluninzi lwePD okanye iziphumo zonyango lotyando olubi; abo bane-esophageal perforation ngexesha lonyango lwePD Kwabo basengozini enkulu, inokusetyenziswa ngokudibanisa nePD; ingasetyenziselwa ukutshintshwa kokuhlinzwa okanye unyango lwePD.
(2) Izinto ezichaseneyo:Ayikhuthazwa kunyango lodidi lokuqala lwe-AC kwizigulane eziselula (≤40 iminyaka ubudala).
03I-Endoscopic Balloon Dilation (PD)
Ukwandiswa kwebhaluni kuneziphumo ezithile kwi-AC, kodwa kufuna unyango oluninzi kwaye ithwala umngcipheko weengxaki ezinzulu.
(1) Iimpawu:Izigulane ze-AC ngaphandle kokungasebenzi kakuhle kwe-cardiopulmonary, i-coagulation dysfunction, njl.; amadoda angaphezu kweminyaka engama-50 kunye nabasetyhini abangaphezu kweminyaka engama-35 ubudala; izigulane ezingaphumelelanga utyando. Ingasetyenziselwa njengendlela yokuqala yonyango yokukhetha.
(2) Izinto ezichaseneyo:Ukungaphumeleli okukhulu kwe-cardiopulmonary, ukungasebenzi kakuhle kwe-coagulation kunye nomngcipheko ophezulu wokubhoboza kwe-esophageal.
04Peroral Endoscopic Myotomy (POEM)
Kwiminyaka yakutshanje, kunye nokuphunyezwa okukhulu kwe-peroral endoscopic myotomy (POEM), izinga lokuphumelela kwonyango lweklinikhi ye-AC liye landa kakhulu.Unyango lwe-POEM lwe-AC luhambelana kakhulu nombono othi "utyando oluncinci oluncinci", oko kukuthi, izilonda kuphela zisuswe / zisuswe ngexesha lonyango, kwaye izitho azisuswanga.Ukunyaniseka kunye nokusebenza kwesakhiwo se-anatomical kugcinwa, kwaye umgangatho wobomi besigulane emva kokusebenza ngokusisiseko awuchaphazeleki. Ukuvela kwePOEM kwenze ukuba unyango lwe-AC lube lula kakhulu.
Umzobo: Amanyathelo otyando oMbongo
Ukusebenza kwexesha eliphakathi kunye nexesha elide le-POEM kunyango lwe-AC luhambelana ne-laparoscopic Heller myotomy (LHM)inokusetyenziswa njengokhetho lonyango lodidi lokuqala.Ezinye izigulana zinokuhlakulela iimpawu ze-reflux ye-gastroesophageal emva kotyando lwe-POEM
(1) Iimpawu ezipheleleyo:I-AC ngaphandle kokuncamathela okubukhali kwe-submucosal, ukuphazamiseka kokusebenza kwesisu kunye ne-diverticulum enkulu.
(2) Iimpawu ezinxulumeneyo:Ukusabalalisa i-spasm ye-esophageal, i-nutcracker esophagus kunye nezinye izifo ze-esophageal motility, izigulana ezine-POEM engaphumeleliyo okanye utyando lwe-Heller, kunye ne-AC kunye ne-esophageal submucosal adhesions.
(3) Izinto ezichaseneyo:Izigulane ezine-coagulation enzima yokungasebenzi kakuhle, isifo esinzima se-cardiopulmonary, imeko embi jikelele, njl. abangakwazi ukunyamezela utyando.
05Laparoscopic Heller Myotomy (LHM)
I-LHM inokusebenza kakuhle kwexesha elide ekuphatheni i-AC, kwaye ngokusisiseko ithathelwe indawo yi-POEM kwiindawo apho iimeko zivuma.
06Utyando lwe-Esophagectomy
Ukuba i-AC idityaniswe ne-esophageal scar stenosis, i-tumor, njl., utyando lwe-esophagectomy lunokuqwalaselwa.
Thina, i-Jiangxi Zhuoruihua Medical Instrument Co., Ltd., ngumvelisi e-China ogxile kwizinto ezityiwayo ze-endoscopic, ezifanai-biopsy forceps, i-hemoclip, polyp umgibe, inaliti ye-sclerotherapy, fafaza i-catheter, iibrashi zecytology, guidewire, ibhasikithi yokubuyiswa kwamatye, i-catheter ye-biliary drainage yeempumlonjl ezisetyenziswa ngokubanzi kwiI-EMR, ESD,I-ERCP. Iimveliso zethu ziqinisekisiwe nge-CE, kwaye izityalo zethu ziqinisekisiwe nge-ISO. Impahla yethu ithunyelwe eYurophu, kuMntla Melika, kuMbindi Mpuma kunye nenxalenye yeAsia, kwaye ifumana ngokubanzi umthengi wokuqatshelwa kunye nendumiso!
Ixesha lokuposa: Jul-09-2024